8. +
Progress
Mx Backslab, elevate-high
risk compartment Sx
Ortho ref - seen in rooms
2/7 later
Admitted 11/7 later for ORIF
2x screws inserted, 6/52
non wt bearing in backslab
9. +
LisFranc
Jacques Lisfranc de St Martin 1790-1847 French
Surgeon/Gynae described injury 1815 after War of
the 6th Coalition-falls from horses
The Lisfranc joint 5 tarso-metatarsal joints.
The Lisfranc ligament from medial cuneiform to
base 2nd MT
LisFranc injuries
Lig rupture
Lig Avulsion
Subluxation/Dislocation-assoc # MT
up to 20% are Lisfranc joint injuries missed
10. +
Diagnosis
Mechanism-rotation, twisting, fall off
horse, severe axial load- MCA, fall
Point tenderness over midfoot
Plantar ecchymosis sign
Wt bearing xrays
13. +
Calcaneal Fractures
Fall from height onto heels-axial
load
Associated injuries
other calcaneal #
spinal wedge #
pelvis
14. +
Bohler’s Angle
Intersection of 2 lines
Line from post articular
surface calcaneus to
anterior articular process of
calc
Post art process to sup
angle of calc tuberosity
Normal 20-40° Abnormal
if < 20°
15. +
Calcaneal #
Image with CT-often worse #
than appears on plain films-ref
all to ortho
Calcaneal # without extension
into subtalat jt and minimal
displacement-can consider
conservative Mx-watch for
achilles tendon causing further
displacement of #
If significant displacement
and/or involvement Subtalar
joint=ORIF
16. +
Horizontal #
2 types
Most common-post sup angle of calc
without achilles tendon insertion
involvement “beak” # – from direct
trauma eg kick
Avuslion # of achilles tendon from
sudden calf muscle contraction
Thompson Test
http://www.youtube.com/watch?v=AmDi08rlR3I
Mx Ortho ref - ORIF
17. +
# Base 5th MT
Jones or not?
Jones fracture = transverse # of
proximal diaphysis of 5th MT, 10-
20mm from the proximal end. Sir
Robert Jones 1902 while dancing
“Pseudo Jones” = Avulsion # of the
tuberosity of the base of 5th MT
Most common lower limb #
From forceful inversion (“sprained
ankle”)-Peroneus Brevis
“sprained ankle” palp base 5th MT-
Ottawa foot rules
18. +
Golden Rule:
If fracture enters or distal to
the intermetatarsal joint =
Jones fracture
If it enters cubo-metatarsal
joint = Pseudo Jones/Avulsion
19. +
Why differentiate?
Jones
high non-union rate Rx due to poor
blood supply and tension from
tendons
Rx - non wt bearing cast 6/52
Pseudo Jones
Cast shoe/CAM walker 4/52
20. +
Jones or Pseudo? 19yo Basketballer –Inversion injury
23. +
References
Emedicine -Lisfranc
Tintinalli et al, Emergency Medicine
Max Esser and his book-Practical Fracture Management, R
McRae, Max Esser
Wheeless Textbook of Orthopaedics online